Rethinking Medical Ethics

Rethinking Medical Ethics: A View from Below and Mountains beyond Mountains are two readings that will be further analyzed to demonstrate how re-socializing and re-humanizing medicine concurrently may be of importance to global health. As a recap, the former is a philosophical work that gives context to the idea of re-socialization in the medical field (Farmer). The latter is a literary, non-fictional piece that documents the life of Paul Farmer, from his early upbringing to his involvement with treating infectious diseases, from a third-person point of view (Kidder). From engagement with these readings, I have found the critical assessment of the upstream causes of health inequality as it pertains to a particular country's political, economic

and social context, as well as the value placed in the human experience to be of great insight. Therefore, I plan to elaborate on the re-socialization and re-humanization of the medical realm in terms of recognizing systemic forms of oppression and utilizing a holistic approach on behalf of health professionals.
Generally speaking, there is a wide outcome gap between the countries that are deemed wealthy and those that are considered to be highly underserved. Illness, specifically infectious diseases, seem to be the most prevalent in populations that are stricken with poverty. Clinical trials are conducted in these areas as a means to avoid the high costs of implementing the studies in the first place and guarantee adequate, patient enrollment. Ethical issues arise when there is no planned intervention to mitigate the spread of disease and the individuals from impoverished countries are not granted access to treatment for their health condition.According to Farmer, the underprivileged embody the injustices that persist in the medical and public-health field and the cycle of health inequality will continue unless those with power in these sectors become aware of the upstream causes of poverty, and in turn, health disparities and then take action.
Rethinking Medical Ethics: A View from Below expands on these issues of current medical ethics and how there should be a re-socialization and re-humanization of such in order to address the outcome gap between the rich and poor and advocate for those who are disproportionately affected by infectious diseases (Farmer).

For instance, it is imperative for leaders in this field to examine the problems that have been of major focus in other disciplines, such as the social sciences, to get a more accurate depiction of the underlying causes of health inequality and why these determinants have a significant leverage in health outcomes. Examples of social determinants include education, quality of housing, working conditions and access to clean water. With that being said, this approach would give ethicists the necessary tools to pinpoint various forms of systemic oppression, better known as the "upstream causes," which contribute to disparities in these factors and health. Moreover, there are key instances of systemic oppression in Kidder's Mountains beyond Mountains and their detrimental impact on the lives of those who live in impoverished populations, in terms of the high rates of tuberculosis and lack of access to

treatment.
In the biographical piece, the author details the life of Paul Farmer, a well-renown physician and anthropologist who devotes his time treating patients suffering from the physiological effects of tuberculosis. At first, Kidder does not understand Farmer's reasoning for caring for small populations experiencing health issues in low-income countries, since treatment is expensive and the money can be used to save the lives of a larger populace. Kidder's perception reflects how the healthcare system operates today, where this is a focus on intervention rather prevention in the communities that can afford medical care and the impoverished populations are left to face the consequences of systemic oppression. For example, a dam is constructed in a low-income area on behalf of those with social, political and economic power (Kidder). One may not be able to comprehend how building this embankment directly affects an individual's well-being; the evidence of this relationship lies in the displacement of communities to make this construction possible as well as the decline in water quality and sanitary conditions. Another form of oppression is the presence of war — civilian deaths and the destruction of facilities that are meant to support the underserved reinforce the cycle of poverty, thus creating a suitable environment for tuberculosis to thrive. Therefore, acknowledging the upstream causes of health disparities is an essential step in re-socializing medicine; improving global health also calls for the need to listen to the stories of the underprivileged, in order to bring about re-humanization in the medical sector.
Pursuing a holistic approach in medicine where health professionals value the human experience can be an opportunity for discovering forms of systemic oppression that are not as apparent as the ones previously mentioned.

In addition, more emphasis on treatment would be placed on the individual, instead of the disease itself. Narrative-based medicine, in particular, centers on the importance of patient's stories in developing effective interventions grounded in the interpretation of their accounts as well as improving communication in the patient-provider relationship. In Mountains beyond Mountains, the people's narrative gives insight on their history (medical, social or economic) prior to contracting the illness, how they are coping with the illness and what needs to change in terms of the quality and accessibility to treatment. The patient's perception of their illness can also be extracted from the narrative, which adds much clarity to the context of

disease.
In summary, the re-socialization and re-humanization of medicine obligates the recognition of systemic forms of oppression or upstream causes of ill-health, as it relates to a specific population, and the inclusion of the people's narrative to improve global health. Furthermore, Kidder and Farmer's work help elucidate the ethics of structural inequality; the concept itself represents the culmination of injustice in the political, social and economic realm and the presence of such is evident in the patient's stories in Rethinking Medical Ethics: A View from Below and Kidder's piece, in terms of their experience with tuberculosis. However, if the idea of structural inequality is applied to Mountains beyond Mountains, the portrayal of Paul Farmer and the work he has done to mitigate infectious diseases in low-income countries may become groundwork for the author's interpretation of this theory.